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Safe staffing champion: ‘role was my chance to be loud and proud and promote nursing’

As she prepares to retire, RCN Scotland director reflects on nursing and the challenges of COVID-19
Theresa Fyffe, RCN Scotland director, who will retire in January 2021

As she prepares to retire, RCN Scotland director reflects on nursing and the challenges of COVID-19

  • COVID-19 may have altered her final year in the profession, but Theresa Fyffe says it has certainly highlighted the importance of nurses
  • Her passion has always been to promote nursing as a skilled and knowledgeable profession, through roles in teaching, clinical practice, policy and government
  • Change can take time, but there is still much work to be done on the senior charge nurse role in Scotland, she says

Like most of us, RCN Scotland director Theresa Fyffe had lots of plans for this year.

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As she prepares to retire, RCN Scotland director reflects on nursing and the challenges of COVID-19

  • COVID-19 may have altered her final year in the profession, but Theresa Fyffe says it has certainly highlighted the importance of nurses
  • Her passion has always been to promote nursing as a skilled and knowledgeable profession, through roles in teaching, clinical practice, policy and government
  • Change can take time, but there is still much work to be done on the senior charge nurse role in Scotland, she says
Theresa Fyffe, RCN Scotland director, who will retire in January 2021
Theresa Fyffe is set to retire in January 2021 Picture: Greg Macvean

Like most of us, RCN Scotland director Theresa Fyffe had lots of plans for this year.

Due to retire in January 2021, she had lined up a full programme of events and activities intended to celebrate the International Year of the Nurse and Midwife.

COVID-19 threw the Year of the Nurse off course

It was also supposed to be the year when ground-breaking safe staffing legislation was implemented in Scotland, something she’d campaigned hard to achieve. It should have been quite the swan song – but along came COVID-19.

‘There was a really exciting start to the year,’ Ms Fyffe says. ‘We were busy planning what we were doing to celebrate the Year of the Nurse. We had a number of projects about making nurses visible, particularly stressing how knowledgeable and skilled they are – that sense of what they do.

‘Nothing we had planned could happen. But the value of nurses and nursing has been well and truly illustrated as a result of COVID-19. It has shown their knowledge, skills and expertise. The sad bit about it is that it’s taken a pandemic to make it evident why you need registered nurses and healthcare support workers.’

Nursing presents unique opportunities and ways to connect with people

Promoting nursing as a skilled and knowledgeable profession has been Ms Fyffe’s creed, almost from the point at which she began her training in her hometown of Dublin.

Throughout her career, which has included stints in practice education and in government, she has always felt there was something unique about nursing and its contribution to the lives of patients, families and society more broadly.

‘I was fortunate in my time in practice to have experienced many moments as a nurse that I still hold in my head,’ she says. ‘Moments that when you look back on you can’t quite believe that you’ve been given that time when you’re doing something for someone or a family that is just so special, so personal, and a time that you can never recreate.’

She recalls one particular experience that has stayed with her. ‘I was caring for a lovely woman who had cardiac problems and went for surgery and it didn’t work. Before going in she was very frightened and genuinely believed she wouldn’t survive it. She decided that because she had a big family it was the right thing to do.’

Ms Fyffe’s voice breaks at the memory.

‘I had to go alongside her knowing that she was doing something she probably would have liked not to have done. Her family were equally torn, because they wanted her to live. I ended up being with that family and her to the end. She didn’t survive and I had to help the family and her.

‘It had a powerful impact on me because I came out recognising that the time I spent at her bedside with her and her family was so profound. They allowed me to be part of their life for that difficult period.’

A fascination for policy led to a role in the Scottish Government

Ms Fyffe was 22 at the time and working in Edinburgh in intensive care nursing.

‘I’m a natural traveller and I finished my training and went to work in London, then I moved to Edinburgh. I worked in many other places, but I started my career as a staff nurse in the UK.’

She has worked in various clinical and practice education roles, having developed a passion for teaching – ideally combined with nursing in practice – very early in her career. But in 2000, it was time for a different challenge, working at the Scottish Executive Health Department (SEHD – now the Scottish Government) in a newly-devolved Scotland.

‘I had a fascination for policy. I wanted to understand how it comes about, and what difference it makes. I felt the best place to do that was to work in government.’

‘The value of nurses has been well and truly illustrated by COVID-19. The sad bit is that it’s taken a pandemic to make it evident why you need registered nurses’

Her time with SEHD included work to define and improve the role of the senior charge nurse, but it also brought the lesson that change can take time.

‘We managed to initiate work on the senior charge nurse as a result of policy changes, but even now it’s still the area where I wanted more to be done.’

This topic was actually to have been a key part of RCN Scotland’s activities for the International Year of the Nurse and Midwife, she says, with a film and campaign on the issue ready to go, until it was interrupted by COVID.

‘It’s frustrating to realise at the end of my career that something I’ve been passionate about getting right is still something where we have more to do,’ she says.

Building relationships to ensure respect for nursing

She moved to the RCN in 2007 to a post that brought together her interest in policy, trade union principles and getting it right for those who are looking after people. It also gave her the chance to advocate for her profession in a role representing 40,000 RCN members in Scotland.

‘This was a chance to be loud and proud and speak about nursing in a way that I really wanted to, but also to establish a really good cohort of multidisciplinary people working together in primary care.

‘Relationship building was part of my way of ensuring that nursing and its unique nature was respected whether it’s in social care or in the context of a multiagency team.’

Ms Fyffe in her first year as director of RCN Scotland Picture: Gary Doak

Supporting members in their roles during the pandemic

However challenging 2020 has been so far, Ms Fyffe has concerns about how to support the nursing workforce as it heads into winter and further waves of the pandemic.

‘During the early stages, I and my executive colleagues felt that we should be there for our members, that we had to do our best to ensure they could do what they were doing so well, with the right support and the right personal protective equipment and everything else in place.’

‘You have to be prepared to go into the room knowing you aren’t going to have the support of everyone and still be able to voice why you believe something needs to happen’

It was a challenging time because nurses were left exhausted, and now, while many have not had a chance to recover, they are having to do it all over again, she says.

The RCN has worked with health boards and Scotland’s health secretary Jeane Freeman to try to promote the health and well-being of nurses, at this difficult time.

Short-staffing and the COVID-19 pandemic

It is a balance, Ms Fyffe says, in getting the health service up and running again while coping with a second wave.

‘I would commend the work that Scotland is trying to do around health and well-being and the resources that have been put in place,’ she says.

‘Health boards have tried to get the balance between getting the service up and running again and managing staff needs. But, as ever, the tension will come between maintaining and keeping a service open with high levels of admissions.’

The pandemic has highlighted how much we need registered nurses and healthcare support workers, says Ms Fyffe Picture: Alamy

There were areas of Scotland that were short of staff before COVID, she says, and the issue remains.

‘Obviously, the legislation wasn’t implemented in the first stages of the pandemic and so we have to continue raising concerns and issues about staffing. Areas are now struggling with staffing as we try to get services up and running and as infection rates rise and there are more admissions to hospital, that will be challenging for our members.

‘If anything, COVID has highlighted why we need to do this work.’

Scotland’s pioneering safe staffing act

The Health and Care (Staffing) (Scotland) Act is the first legislation of its kind in the UK to apply to all clinical groups in health and social care services.

It sets out the process for decision-making on safe staffing and is clear about who is accountable for providing the right numbers, with the right skills, to ensure safe and effective care.

This isn’t just for the NHS, but the independent sector too, including care homes and hospices, says Ms Fyffe, who is leading a piece of work for the RCN on the independent sector across the UK.

Implementation of the safe staffing legislation was supposed to begin in April 2020 and work on drawing up guidance and processes for bringing it into practice should have concluded this autumn, but it has been put on hold.

When it is finally implemented, however, Ms Fyffe believes the legislation will make a positive difference to the lives of patients as well as nurses.

Ms Fyffe speaking at the RCN Jobs Fair in Glasgow in 2014 Picture: Mike Wilkinson

Resilience and maintaining principles

In her own career, Ms Fyffe had been told by colleagues when she left the NHS to work for government that she would be ‘poacher turned gamekeeper’ – then was told the same again when she joined the RCN. ‘The thing I’m proud about is that I had the integrity to do whichever job it was with the same principles.

‘It has not always been comfortable when I’ve had to make a stand,’ she says, citing safe staffing legislation as an example.

‘We put in hours of work as a college to make that happen, and when we were lobbying for the changes I was put under pressure at some points not to ask for some things.

‘It was hard to find yourself at the college being the only person in the room arguing for something. You have to find resilience; you have to be prepared to go into the room knowing you aren’t going to have the support of everyone and still be able to voice why you believe something needs to happen.’

Retiring with a proud legacy

It is clear that Ms Fyffe will be missed.

When her retirement was made public in September, RCN general secretary Dame Donna Kinnair said she would be leaving behind a ‘real legacy’.

‘Theresa has been an outstanding colleague and leader for the RCN, as well as a great source of support and advice to me, personally,’ she said.

‘Her passion for nursing, her dedication and commitment to the profession and her remarkable leadership abilities and sense of vision have made a real difference – both to the organisation and to the members we represent.’

Theresa Fyffe’s career timeline

1978 Qualified as a registered nurse at St Lawrence’s Hospital, Dublin

1978-1982 Clinical roles in London

1982-1990 Clinical nurse lecturer in Bristol and Edinburgh

1991-1992 In-service education in Edinburgh which became a practice development post

Two years into her role as director of RCN Scotland, Ms Fyffe visits the emergency department at Edinburgh Royal Infirmary Picture: Ashley Coombes/Epicscotland

1993-1997 Senior nurse practice development

1997-1999 Director practice, research and continuing professional development

1999-2000 Head of nursing services

2000-2006 Nursing officer, Scottish Executive Health Department (SEHD)

2006-2007 Deputy chief nursing officer (interim), SEHD

2007-present Director, RCN Scotland

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